Provider Demographics
NPI:1437048659
Name:KIERNAN, LAURA MICHELE (LSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N WABASH AVE STE 515
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4818
Mailing Address - Country:US
Mailing Address - Phone:312-554-5603
Mailing Address - Fax:312-554-5603
Practice Address - Street 1:17 N WABASH AVE STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4818
Practice Address - Country:US
Practice Address - Phone:312-554-5603
Practice Address - Fax:312-554-5603
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1121251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical